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Epilepsy Pre-Conception Counselling – Comprehensive — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEpilepsy Pre-Conception Counselling – ComprehensiveSCE Neurology

A man with Parkinson disease taking pramipexole develops compulsive gambling and secret online spending. Motor control is otherwise good and he retains decision-making capacity. What is the most appropriate medication response?

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Correct answer: A — Reduce the dopamine agonist gradually with specialist motor-plan adjustment

Impulse-control disorder is strongly associated with dopamine agonists. The treatment is specialist-supervised gradual reduction or withdrawal, with adjustment of other motor therapy and monitoring for dopamine-agonist withdrawal syndrome. Adding psychotropics while preserving the driver is inadequate, abrupt cessation can cause a severe withdrawal syndrome, and reducing levodopa instead does not address the principal trigger.

Reference: NICE NG71 Parkinson disease in adults: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng71/chapter/Recommendations